[How many MRI sequences are required for prostate cancer detection?]

Multiparametric magnetic resonance imaging (mpMRI) is an established imaging modality for prostate cancer. In this context, "multiparametric" refers to the combination of anatomical sequences (T1- and T2-weighted) with functional (diffusion-weighted) and contrast-enhanced sequences. Anatomical sequences offer high spatial resolution, while diffusion-weighted imaging (DWI) assesses the movement of water molecules within tissues, providing information on tissue composition. The contrast-enhanced sequence (Dynamic Contrast-Enhanced, DCE) evaluates tissue perfusion to identify potential tumour angiogenesis. This combination of sequences allows a comprehensive assessment of various aspects of prostate tissue. However, growing evidence suggests that not all sequences are always required. For early detection of prostate cancer, MRI without DCE (=biparametric MRI, bpMRI) should be the standard, because it exhibits similar detection rates for clinically significant prostate cancer. In special cases, such as after previous prostate treatments (e.g., after focal therapy), radiological challenges (e.g., hip replacement), or in cases of negative bpMRI findings with persistent suspicion of prostate cancer, adding DCE may be helpful. MRI screening without DCE is safer, less expensive, and reduces gadolinium emissions. The final results from the prospective, multicentre PRIME study (bpMRI vs. mpMRI before biopsy) are still pending and will further clarify the role of DCE in early detection.